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Martin JZ, Onieva JL, Roman A, Garrido M, Oliver J, Martinez-Galvez B, Dubbelman J, Mesas A, Villatoro R, Ramos I, Rueda-Dominguez A, Perez-Ruiz E, Benitez JC, Medina JA, Alba E, Sett RC, Barragan I. Dynamic Exosome Analysis to Predict Response to the Combination of SABR and Immunotherapy in Oligoprogressive Disease. Int J Radiat Oncol Biol Phys 2023; 117:e274-e275. [PMID: 37785033 DOI: 10.1016/j.ijrobp.2023.06.1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Up to 80% of metastatic patients face resistance to immune checkpoint inhibitors (ICI). Combined SABR and ICI (I-SABR) can unleash antitumor immune cascades to overcome resistance and improve response with minimal toxicity. This synergy is particularly interesting in the oligoprogressive setting to extend the clinical benefit (CB) of ICI. However, there are no current biomarkers for patient selection. We hypothesize that differential expression of exosomal RNA in liquid biopsy may predict response to I-SABR. MATERIALS/METHODS Ongoing prospective multicenter study in two cohorts. Cohort A consists of metastatic patients in oligoprogression to ICI (1-5 extracranial sites) but maintaining the same ICI due to CB and who receive concomitant SABR (35 Gy in 5 fractions, fx) to oligoprogressive sites. Cohort B is a comparative group of oligometastatic patients receiving only SABR in ablative doses. Blood samples are extracted before SABR (T1), after the first (T2) and last (T3) fx, two months post-SABR (T4) and at further progression (TP). Response is evaluated by iRECIST and defined by the objective response rate (ORR) in all lesions (in and out-of-field)- complete and partial responses. For exosome analysis, we perform RNA isolation and small RNA sequencing from plasma. We use Cutadapt, Bowtie and featureCounts to quantify the number of reads of miRNA, small nuclear RNA (snRNA) and small nucleolar RNA (snoRNA). Pairwise differences in expression in responders and non-responders are examined by DESeq2 differential expression analysis. Differentially expressed transcripts are consulted in Ingenuity Pathway Analysis (IPA). RESULTS Of 22 patients recruited, we present preliminary results of the first 10 (8 from cohort A and 2 from B) that had undergone re-evaluation after SABR. Most frequent cancer types were lung (60%) and renal cell (20%). Seventy percent were polymetastatic (>5 lesions) and 90% had a single progressing site. Pembrolizumab (40%) and Nivolumab (30%) were the most frequent ICI. Most lesions for SABR were lung (45%). With a median follow-up of 7.1 months (95% CI, 3.7-10.6) ORR at two months was 60% (6 partial responses, 1 stable disease and 3 progressions). Median progression-free survival was 10.3 months (95% CI, 3.7-not reached) and median overall survival was not reached. Seven patients in cohort A were available for small RNA analysis. We identified 3 miRNA, 24 snRNA and 9 snoRNA that were significantly differentially expressed at T1. Hsa-miR-493, marker of tumor progression, was upregulated in non-responders. RN7SK inhibits LAS1L (a known inductor of metastasis in lung cancer) and was upregulated in responders. SNORD71, which is inhibited by ILF3 (promotor of progression), was also upregulated in responders. CONCLUSION I-SABR is an effective approach for extending CB of ICI in oligoprogressive patients. Exosomal RNA expression analysis in liquid biopsy is a novel and non-invasive technique that may predict response to this combination and aid in patient selection.
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Affiliation(s)
- J Zafra Martin
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Department of Radiation Oncology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - J L Onieva
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - A Roman
- Department of Radiation Oncology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - M Garrido
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - J Oliver
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - B Martinez-Galvez
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - J Dubbelman
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - A Mesas
- Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - R Villatoro
- Department of Medical Oncology, Costa del Sol Hospital, Marbella, Spain
| | - I Ramos
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - A Rueda-Dominguez
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - E Perez-Ruiz
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - J C Benitez
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - J A Medina
- Department of Radiation Oncology, Virgen de la Victoria University Hospital, Malaga, Spain
| | - E Alba
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Medical Oncology Intercenter Unit, Regional and Virgen de la Victoria University Hospitals, Malaga, Spain
| | - R Chicas Sett
- Department of Radiation Oncology, La Fe University Hospital, Valencia, Spain; Department of Radiation Oncology, ASCIRES Grupo Biomedico, Valencia, Spain
| | - I Barragan
- Group of Translational Research in Cancer Immunotherapy, Health and Medical Research Centre (CIMES), University of Malaga (UMA), Institute of Biomedical Research in Malaga (IBIMA), Malaga, Spain; Group of Pharmacoepigenetics, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Hamm RM, Kelley DM, Medina JA, Syed NS, Harris GA, Papa FJ. Effects of using an abdominal simulator to develop palpatory competencies in 3rd year medical students. BMC Med Educ 2022; 22:63. [PMID: 35081956 PMCID: PMC8793257 DOI: 10.1186/s12909-022-03126-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical school faculty are hard pressed to provide clerkship students with sufficient opportunity to develop and practice their capacity to perform a competent clinical examination, including the palpatory examination of the abdomen. We evaluated the impact of training with an abdominal simulator, AbSim, designed to monitor the depth, location, and thoroughness of their palpation and to provide concurrent and summative feedback regarding their performance. METHODS All third-year medical students were given the opportunity to develop their palpatory skills with the AbSim simulator during the family medicine rotation. The performance of those who studied with the simulator was measured by its sensors, before and after a training session that included visual feedback regarding the depth and coverage of the student's manual pressure. Additionally, all students reported their confidence in their evolving abdominal palpation skills at the beginning and end of the rotation. RESULTS 119 (86.9%) of 137 students filled out the initial questionnaire, and 73 (61.3%) studied with the abdominal simulator. The training produced a highly significant improvement in their overall performance (4 measures, p's < 0.001). Pre-training performance (depth calibration and thoroughness of coverage) was not related to the number of months of previous clinical rotations nor to previous internal medicine or surgery rotations. There was little relation between students' confidence in their abdominal examination skills and objective measures of their palpatory performance; however, students who chose the training started with less confidence, and became more confident after training. CONCLUSIONS Guided abdominal simulator practice increased medical students' capacity to perform an abdominal examination with more appropriate depth and thoroughness of palpation. Interpretation of changes in confidence are uncertain, because confidence was unrelated to objectively measured performance. However, students with low initial confidence in their abdominal examination seemed to be more likely to choose to study with the abdominal simulator.
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Affiliation(s)
- Robert M Hamm
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 900 NE 10th St., Oklahoma City, OK, 73104, USA.
| | - David M Kelley
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 900 NE 10th St., Oklahoma City, OK, 73104, USA
| | - Jose A Medina
- Physician Associate Program, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Noreen S Syed
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 900 NE 10th St., Oklahoma City, OK, 73104, USA
| | - Geraint A Harris
- Great Plains Family Medicine Residency Program, Oklahoma City, OK, USA
| | - Frank J Papa
- Texas College of Osteopathic Medicine, University of North Texas, Fort Worth, TX, USA
- ACDET, Inc., Fort Worth, TX, USA
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Zapata I, Alvarez M, Hidalgo R, Pajares B, Garcia-Anaya MJ, Toledo MD, Trigo JM, Lupiañez-Perez Y, Medina JA, Jaime Gomez-Millan J. Causes of death in patients with locally advanced head and neck cancer treated with radiotherapy and systemic therapy. BMC Cancer 2019; 19:1241. [PMID: 31864338 PMCID: PMC6925882 DOI: 10.1186/s12885-019-6427-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To investigate the incidence of non-cancer mortalities and prognostic factors associated with competitive causes of death in a homogeneous cohort of patients with locally advanced head and neck cancer treated with radiotherapy and systemic treatment. METHODS This study included 284 patients with locally advanced head and neck cancer treated with radiotherapy and systemic treatment between 2005 and 2017. The cumulative incidence of death associated with tumour, second tumours, treatment, side effects and comorbidity was calculated. A Fine and Gray regression model was used to investigate factors associated with cancer and competitive mortality. RESULTS The cumulative incidence of tumoral death at 5 and 10 years were 35 and 47% respectively, whereas the cumulative incidence of competitive mortality were 10 and 12% respectively. In the multivariate analysis, age and comorbidity were independent factors for non-cancer mortality. Patients with a high risk of non-cancer mortality presented a cumulative incidence of 17.3% at 5 years and 18.4% at 10 years. CONCLUSIONS This study demonstrated a high incidence of competing mortality in older patients with comorbidities. Non-cancer deaths should be considered when selecting patients for combination therapies and in the study design ofclinical trials.
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Affiliation(s)
- I Zapata
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - M Alvarez
- Laboratorio de biología molecular del cancer, centro de investigaciones medico-sanitarias (CIMES), Universidad de Málaga, Malaga, Spain.,Instituto de investigación biomédica de Malaga, Campus Teatinos s/n., 29010, Malaga, Spain.,Pathology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - R Hidalgo
- Servicio central de Informatica, Universidad de Malaga, Malaga, Spain
| | - B Pajares
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - M J Garcia-Anaya
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - M D Toledo
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - J M Trigo
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - Y Lupiañez-Perez
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - J A Medina
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - J Jaime Gomez-Millan
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain. .,Instituto de investigación biomédica de Malaga, Campus Teatinos s/n., 29010, Malaga, Spain.
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Oliver JA, Gómez-Millán J, Medina JA, Cabeza L, Perazzoli G, Jimenez-Luna C, Doello K, Ortiz R. O6-methylguanine-DNA Methyltransferase Promoter Methylation in Patients with Rectal Adenocarcinoma After Chemoradiotherapy Treatment: Clinical Implications. Balkan Med J 2019; 36:283-286. [PMID: 31199091 PMCID: PMC6711248 DOI: 10.4274/balkanmedj.galenos.2019.2018.12.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aims: To analyze the clinical relevance of O6-methylguanine-DNA methyltransferase in rectal adenocarcinoma treated with chemoradiotherapy followed by surgery. Methods: Tissue samples from 29 rectal adenocarcinoma patients were obtained after chemoradiotherapy. O6-methylguanine-DNA methyltransferase promoter methylation status was established by methylation-specific polymerase chain reaction. O6-methylguanine-DNA methyltransferase protein levels were determined by immunohistochemistry. Clinicopathologic variables, including treatment regression grade, recurrence, lymph node invasion, and stage and differentiation grade of the tumor, were determined. Results: The O6-methylguanine-DNA methyltransferase gene promoter was methylated in 81.5% of samples. Most patients (88.9%) showed low O6-methylguanine-DNA methyltransferase protein expression. O6-methylguanine-DNA methyltransferase methylation status was not correlated with any of the clinicopathological variables determined in rectal adenocarcinomas selected for chemoradiotherapy. Conclusion: O6-methylguanine-DNA methyltransferase methylation status is not correlated with clinicopathologic variables examined in rectal adenocarcinoma selected for chemoradiotherapy, although its role as a biomarker awaits further investigation.
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Affiliation(s)
- Jaime A. Oliver
- Center for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK,Institute of Biopathology and Regenerative Medicine, Center of Biomedical Research, University of Granada, Granada, Spain
| | - Jaime Gómez-Millán
- Department of Radiation Oncology, Universitary Hospital Virgen de la Victoria, Málaga, Spain
| | - Jose A. Medina
- Department of Radiation Oncology, Universitary Hospital Virgen de la Victoria, Málaga, Spain
| | - Laura Cabeza
- Institute of Biopathology and Regenerative Medicine, Center of Biomedical Research, University of Granada, Granada, Spain,Department of Anatomy and Embryology, University of Granada, Granada, Spain,Biosanitary Institute of Granada (ibs. GRANADA), SAS-Universidad de Granada, Granada, Spain
| | - Gloria Perazzoli
- Institute of Biopathology and Regenerative Medicine, Center of Biomedical Research, University of Granada, Granada, Spain,Biosanitary Institute of Granada (ibs. GRANADA), SAS-Universidad de Granada, Granada, Spain
| | - Cristina Jimenez-Luna
- Institute of Biopathology and Regenerative Medicine, Center of Biomedical Research, University of Granada, Granada, Spain
| | - Kevin Doello
- Medical Oncology Service, Universitary Hospital Virgen de las Nieves, Granada, Spain
| | - Raúl Ortiz
- Institute of Biopathology and Regenerative Medicine, Center of Biomedical Research, University of Granada, Granada, Spain,Department of Anatomy and Embryology, University of Granada, Granada, Spain,Biosanitary Institute of Granada (ibs. GRANADA), SAS-Universidad de Granada, Granada, Spain
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Ordoñez R, Otero A, Jerez I, Medina JA, Lupiañez-Pérez Y, Gomez-Millan J. Role of radiotherapy in the treatment of metastatic head and neck cancer. Onco Targets Ther 2019; 12:677-683. [PMID: 30705596 PMCID: PMC6343506 DOI: 10.2147/ott.s181697] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In metastatic or locally advanced head and neck tumors that present in frail patients or after chemotherapy progression, radiotherapy is normally used as a palliative treatment, with a high rate of symptom palliation and improvement in quality of life. However, there is controversy about what the optimal regimen is. Moreover, despite the poor prognosis of metastatic head and neck cancer, different retrospective studies have shown that a minority of patients with oligometastatic disease experience prolonged disease-free survival after adding curative radiotherapy treatment to the metastatic disease and/or primary tumor. Different retrospective studies have identified clinical prognostic factors that may be used to select candidate patients with metastatic head and neck cancer for a radical approach with radiotherapy. The purpose of this manuscript is to review the role of radiotherapy in metastatic and locally advanced head and neck tumors.
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Affiliation(s)
- Rafael Ordoñez
- Department of Radiation Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain,
| | - Ana Otero
- Department of Radiation Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain,
| | - Inmaculada Jerez
- Department of Radiation Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain,
| | - Jose A Medina
- Department of Radiation Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain,
| | - Yolanda Lupiañez-Pérez
- Department of Radiation Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain,
| | - Jaime Gomez-Millan
- Department of Radiation Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain,
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Gomez-Millan J, Pajares B, Perez-Villa L, Carnero A, Alvarez M, De Luque V, Rivas F, Trigo JM, Toledo MD, Alba E, Medina JA. Subcellular localisation of pMEK has a different prognosis in locally advanced head and neck cancer treated with concomitant radiochemotherapy. BMC Cancer 2016; 16:829. [PMID: 27793200 PMCID: PMC5084350 DOI: 10.1186/s12885-016-2869-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/21/2016] [Indexed: 12/30/2022] Open
Abstract
Background MEK1 (MAP2K1) and MEK2 (MAP2K2) are closely related dual-specificity protein kinases which function by phosphorylating both serine/threonine and tyrosine residues of their substrates ERK1 and ERK2, controlling fundamental cellular processes that include cell growth and proliferation. To investigate the prognostic significance of pMEK expression in the nucleus and cytoplasm among patients with locally advanced head and neck cancer treated with concurrent radiochemotherapy. Methods Immunohistochemistry was performed on the retrieved archival tissue of 96 patients to detect pMEK, p53 and Ki-67. Results Sixty-six percent of patients were positive for pMEK expression in the nucleus and 41 % in cytoplasm. On univariate analysis, high nuclear pMEK was predictive of worse 5y-DFS and 5y-OS, with a trend to significance (26 % vs. 41 %, p = 0.09; 36 % vs. 47 %, p = 0.07). High cytoplasmic pMEK was predictive of better 5-y OS and 5-y DFS outcomes (61 % vs. 27 %, p = 0.01; 46 % vs. 22 %, p = 0.02). On multivariate analysis, low cytoplasmic pMEK and high nuclear pMEK predicted worse DFS and OS (p = 0.01; p = 0.04 and p = 0.02; p = 0.02 respectively). Conclusions Subcellular localisation of pMEK has different prognosis in locally advanced head and neck cancer treated with radiochemotherapy.
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Affiliation(s)
- J Gomez-Millan
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain.
| | - B Pajares
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain.
| | - L Perez-Villa
- Pathology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - A Carnero
- Instituto de Biomedicina de Sevilla (IBIS), Consejo superior de investigaciones científicas, Campus Universitario Virgen del Rocío, Avda, Manuel Siurot s/n, 41013, Sevilla, Spain
| | - M Alvarez
- Pathology Department, Facultad de Medicina, UMA, Campus Teatinos s/n, 29010, Malaga, Spain
| | - V De Luque
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - F Rivas
- Agencia Sanitaria Costa del Sol, Unidad de Investigación, Autovia A-7, Km 187, 29063, Marbella, Málaga, Spain.,Red Nacional de Investigación de Servicios de Salud en Enfermedades crónicas (REDISSEC), Madrid, Spain
| | - J M Trigo
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - M D Toledo
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - E Alba
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - J A Medina
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
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Cacicedo J, Navarro A, Del Hoyo O, Gomez-Iturriaga A, Alongi F, Medina JA, Elicin O, Skanjeti A, Giammarile F, Bilbao P, Casquero F, de Bari B, Dal Pra A. Role of fluorine-18 fluorodeoxyglucose PET/CT in head and neck oncology: the point of view of the radiation oncologist. Br J Radiol 2016; 89:20160217. [PMID: 27416996 DOI: 10.1259/bjr.20160217] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Squamous cell carcinoma is the most common malignant tumour of the head and neck. The initial TNM staging, the evaluation of the tumour response during treatment, and the long-term surveillance are crucial moments in the approach to head and neck squamous cell carcinoma (HNSCC). Thus, at each of these moments, the choice of the best diagnostic tool providing the more precise and larger information is crucial. Positron emission tomography with fluorine-18 fludeoxyglucose integrated with CT (18F-FDG-PET/CT) rapidly gained clinical acceptance, and it has become an important imaging tool in routine clinical oncology. However, controversial data are currently available, for example, on the role of 18F-FDG-PET/CT imaging during radiotherapy planning, the prognostic value or its real clinical impact on treatment decisions. In this article, the role of 18F-FDG-PET/CT imaging in HNSCC during pre-treatment staging, radiotherapy planning, treatment response assessment, prognosis and follow-up is reviewed focusing on current evidence and controversial issues. A proposal on how to integrate 18F-FDG-PET/CT in daily clinical practice is also described.
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Affiliation(s)
- Jon Cacicedo
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain.,2 Grupo Español de Oncología Radioterápica en Cabeza y Cuello (GEORCC)
| | - Arturo Navarro
- 3 Radiation Oncology Department, Hospital Duran i Reynals (ICO) Avda, Gran Via de L´Hospitalet, Hospitalet de Llobregat, Barcelona, Spain
| | - Olga Del Hoyo
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Alfonso Gomez-Iturriaga
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Filippo Alongi
- 4 Radiation Oncology Department, Sacro Cuore-Don Calabria Hospital, Verona, Italy
| | - Jose A Medina
- 2 Grupo Español de Oncología Radioterápica en Cabeza y Cuello (GEORCC).,5 Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Olgun Elicin
- 6 Radiation Oncology Department, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Andrea Skanjeti
- 7 Nuclear Medicine Department, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Francesco Giammarile
- 7 Nuclear Medicine Department, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Pedro Bilbao
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Francisco Casquero
- 1 Radiation Oncology Department, Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, Spain
| | - Berardino de Bari
- 8 fESTRO Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Alan Dal Pra
- 6 Radiation Oncology Department, Inselspital, Bern University Hospital, Bern, Switzerland
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Medina JA, Lorea P, Elliot D, Foucher G. Correction of Clinodactyly by Early Physiolysis: 6-Year Results. J Hand Surg Am 2016; 41:e123-7. [PMID: 26972556 DOI: 10.1016/j.jhsa.2016.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 01/28/2016] [Accepted: 02/04/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To review results at least 6 years after physiolysis for treatment of the delta phalanx associated with clinodactyly. METHODS We present 22 cases of clinodactyly treated with physiolysis in which we removed the central part of the epiphysis, which is the portion restricting longitudinal growth unilaterally and inducing progressive finger deviation, and placed a fat graft in the resultant defect. RESULTS This retrospective study reports the results of early physiolysis in 27 fingers with radial clinodactyly, including 17 fingers from 17 patients previously reported and 10 little fingers from 5 additional patients. All patients had a minimum follow-up of 6 years. Mean preoperative angle was 38° (range, 25° to 47°). At final follow-up, mean angle was 8° (range, 0° to 24°), a mean correction of 79%. Twelve fingers in 9 patients had more than 10° of deformity at final follow-up, whereas 15 fingers in 13 patients had a residual deformity of less than 10°, which is effectively full correction of a clinodactyly. No patient required a closing wedge osteotomy later for insufficient correction. CONCLUSIONS These accumulative findings confirm our previous preliminary report. Early physiolysis is a quick and simple procedure that allows for growth and partial but often adequate correction of the clinodactyly. The correction occurs slowly over a period of years, which can be seen as a disadvantage, and requires careful counseling of the parents. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Jose A Medina
- Department of Orthopaedics, Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain
| | - Patrick Lorea
- Department of Orthopaedics, Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain
| | - David Elliot
- Department of Orthopaedics, Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain.
| | - Guy Foucher
- Department of Orthopaedics, Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain
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9
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Medina JA, Elliot D, Giesen T, Foucher G. Long-term function after pseudo-pollicization of the little finger. J Hand Surg Eur Vol 2014; 39:520-5. [PMID: 23877728 DOI: 10.1177/1753193413498191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This article presents a technique for facilitating use of pinch between the ring and little fingers for use in rare cases of congenital absence, or severe hypoplasia, of the thumb in which pollicization of the index finger is impossible, or not advised because the child is already pinching by scissor action between the ring and little fingers. The technique avoids drawing attention to the hand, as is the case after true pollicization of the little finger. The technique was used in five hands in five children. Three of the patients could only be followed for under 2 years. Two patients were available for longer follow-up of 6 years and 2 months and 3 years after surgery. The surgery was shown to facilitate opening of the web and pinch between the little and ring finger tips, and continues to be of functional value to the children as they grow.
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Affiliation(s)
- J A Medina
- Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain
| | - D Elliot
- Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain
| | - T Giesen
- Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain
| | - G Foucher
- Hospital de Gran Canaria, Docteur Pasteur Sin, Las Palmas, Gran Canaria, Spain
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10
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Mesía R, Rueda A, Vera R, Lozano A, Medina JA, Aguiar D, Árias F, Triana G, Carles J, López-López R. Adjuvant therapy with cetuximab for locally advanced squamous cell carcinoma of the oropharynx: results from a randomized, phase II prospective trial. Ann Oncol 2013; 24:448-453. [PMID: 23041591 DOI: 10.1093/annonc/mds291] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cetuximab combined with radiotherapy (RT) is a treatment option for head and neck cancer. The objectives of this randomized, phase II trial were to evaluate the efficacy and safety of cetuximab maintenance therapy following definitive RT with concomitant cetuximab in patients with oropharyngeal cancer. PATIENTS AND METHODS Ninety-one patients with stage III-IV M0 oropharyngeal tumors were randomly assigned to the treatment with accelerated concomitant boost RT (69.9 Gy) + cetuximab or the same treatment with the addition of 12 consecutive weeks of cetuximab maintenance therapy. The primary end point was locoregional control (LRC) at 1 year. RESULTS LRC at 1 year was superior among patients in the experimental arm, treated with cetuximab maintenance (59% versus 47%). However, LRC was similar between both arms after 2 years of follow-up, as a result of increased locoregional recurrences after the first year in the maintenance group. Patients treated with adjuvant cetuximab do recover very soon from toxic effect after combined treatment. CONCLUSIONS Twelve weeks of cetuximab maintenance therapy after concomitant cetuximab + RT in locally advanced oropharyngeal carcinoma is feasible and improves clinical outcomes measured at 1 year. This improvement is not maintained after the second year suggesting that epidermal growth factor receptor blockade is not sufficient to completely eliminate the minimal residual disease.
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Affiliation(s)
- R Mesía
- Medical Oncology Department, IDIBELL, Institut Català d'Oncologia-L'Hospitalet, Barcelona.
| | - A Rueda
- Medical Oncology Department, Complejo Hospitalario Virgen de la Victoria, Málaga
| | - R Vera
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona
| | - A Lozano
- Radiation Oncology Department, IDIBELL, Institut Català d'Oncologia-L'Hospitalet, Barcelona
| | - J A Medina
- Radiation Oncology Department, Complejo Hospitalario Virgen de la Victoria, Málaga
| | - D Aguiar
- Medical Oncology Department, Hospital General Dr Negrín, Las Palmas de Gran Canaria
| | - F Árias
- Radiation Oncology Department, Complejo Hospitalario de Navarra, Pamplona
| | - G Triana
- Radiation Oncology Department, Centro Oncológico Regional de Galicia, A Coruña
| | - J Carles
- Medical Oncology Department, Hospital del Mar, Barcelona
| | - R López-López
- Medical Oncology Department, Complejo Hospitalario Universitario de Santiago, Spain
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11
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Pajares B, Trigo JM, Toledo MD, Álvarez M, González-Hermoso C, Rueda A, Medina JA, de Luque V, Jerez JM, Alba E. Differential outcome of concurrent radiotherapy plus epidermal growth factor receptor inhibitors versus radiotherapy plus cisplatin in patients with human papillomavirus-related head and neck cancer. BMC Cancer 2013; 13:26. [PMID: 23331666 PMCID: PMC3637564 DOI: 10.1186/1471-2407-13-26] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 01/10/2013] [Indexed: 11/24/2022] Open
Abstract
Background Human papillomavirus (HPV)-related head and neck cancer has been associated with an improved prognosis in patients treated with radiotherapy (RT) +/− chemotherapy (CT); however, RT combined with epidermal growth factor receptor (EGFR) inhibitors has not been fully studied in this group of patients. Methods Immunohistochemical expression of p16 and PCR of HPV16 DNA were retrospectively analyzed in tumor blocks from 108 stage III/IV head and neck cancer patients treated with RT+CT (56) or RT+EGFR inhibitors (52). Disease-free survival (DFS) and overall survival (OS) were analyzed by the Kaplan-Meier method. Results DNA of HPV16 was found in 12 of 108 tumors (11%) and p16 positivity in 18 tumors (17%), with similar rates in both arms of treatment. After a median follow-up time of 35 months (range 6–135), p16-positive patients treated with RT+EGFR inhibitors showed improved survival compared with those treated with RT+CT (2-year OS 88% vs. 60%, HR 0.18; 95% CI 0.04 to 0.88; p = 0.01; and 2-year DFS 75% vs. 47%, HR 0.17; 95% CI 0.03 to 0.8; p = 0.01). However, no differences were observed in p16-negative patients (2-year OS 56% vs. 53%, HR 0.97; 95% CI 0.55 to 1.7; p = 0.9; and 2-year DFS 43% vs. 45%, HR 0.99; 95% CI 0.57 to 1.7; p = 0.9). Conclusions This is the first study to show that p16-positive patients may benefit more from RT+EGFR inhibitors than conventional RT+CT. These results are hypothesis-generating and should be confirmed in prospective trials.
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Affiliation(s)
- Bella Pajares
- Department of Medical Oncology, University Hospital Virgen de la Victoria, Málaga, Spain.
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12
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Abstract
OBJECTIVE To validate the efficacy of a radiodermatitis management protocol (which involves preventive measures, the application of preventive creams and the use of a non-adhesive, foam dressing with a silicone contact layer) at a radiation oncology department in southern Spain. METHOD An observational study was carried out on consecutive patients undergoing radiation therapy for sarcomas, ear nose and throat, breast, cervix and lung cancers, excluding patients with other tumours and those who stopped radiation treatment, or who died during its course. Variables that were assessed included: average healing time, general progression of the injury, degree of trauma caused by removing the dressing, convenience and comfort, patient's aesthetic perception, ease of use for health professionals, adaptability, and the length of time for which the dressing stays in place. RESULTS 20 patients were included in the study and radiodermatitis was resolved in 100% (20/20). Optimal progression of all lesions was observed. No infections occurred, and the average total healing time ranged from one to two weeks, even during radiation therapy Patients reported a high level of satisfaction with the dressing, which scored highly in terms of convenience and comfort, atraumatic dressing, ease of use, adaptability, patients' aesthetic perception and adhesive durability. CONCLUSION Our action protocol is effective in the prevention and treatment of radiodermatitis. We achieved optimal results in the current study, which supports the continued use of the test dressing in our department. CONFLICT OF INTEREST None.
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Affiliation(s)
- Y Lupiáñez Pérez
- Health Care District, Centro de Salud de Carlinda, Málaga, Spain.
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13
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López YM, Pilar FJ, Medina JA, López-Herce J, Pons M, Balcells J, Martinón-Torres F, Modesto V, García JA. Courses on mechanical ventilation in pediatrics: first experience in Spain. Pediatr Pulmonol 2007; 42:1072-7. [PMID: 17902146 DOI: 10.1002/ppul.20708] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To analyse the initial experience in mechanical ventilation courses held by the Respiratory Group of the Spanish Paediatric Intensive Care Society. MATERIALS AND METHODS From 2002 to 2006, 15 courses on paediatric mechanical ventilation were held in eight hospitals in Spain, attended by a total of 367 physicians (53.4 % trainees and 46.6 % staff physicians from Paediatrics, Neonatology or Emergency). An initial theoretical written test of 40 questions was completed by participants, followed by short theory classes and practical workshops based on clinical situations, with ventilators and ventilation simulators, with five to seven students per workshop. At the end of the course participants completed a theoretical written test, in which it was considered necessary to answer correctly at least 70% of the questions, a practical evaluation (with assessment grades from 1 to 5) and a written survey about the quality of the course (with assessment grades from 0 to 10). RESULTS In the initial test, only 20% of students answered 70% of questions correctly, whilst in the final test 93% hit this target, (p < 0.001). In the practical evaluation, 96% of students demonstrated sufficient acquisition of practical skills (grades equal to or greater than 3). In the participant survey, the course methodology was rated at 8.7 +/- 0.5, organisation 8.7 +/- 0.4, teaching staff 9.2 +/- 0.2, theoretical classes 8.7 +/- 0.4 and practical sessions 8.8 +/- 0.3. CONCLUSIONS Mechanical ventilation courses are a useful educational method for health professionals in theoretical and practical mechanical ventilation.
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Affiliation(s)
- Yolanda M López
- Pediatric intensive Care Unit, Hospital de Cruces, Baracaldo, Vizcaya.
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14
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Abstract
Microbial phytases suitable for food fermentations could be obtained from lactic acid bacteria isolated from natural vegetable fermentations. Phytase activity was evaluated for six lactic acid bacteria cultures. Although the highest activity was found for Lactobacillus plantarum, the phytase activity was very low. Further characterization of the enzyme with phytate-degrading activity showed a molecular weight of 52 kDa and an optimum activity at pH 5.5 and 65 degrees C. Enzyme activity was due to a non-specific acid phosphatase which had a higher hydrolysis rate with monophosphorylated compounds such as acetyl phosphate that could explain the low phytase activity.
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Affiliation(s)
- M Zamudio
- Facultad de Ingeniería Química, Universidad Autónoma de Yucatán, Mérida, Yucatán, México.
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15
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Mérida FJ, Redondo M, Medina JA, Morell M. Response of hypophyso-thyroid-axis to surgery under halothane anaesthesia. J Physiol Biochem 1999; 55:95-6. [PMID: 10517266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- F J Mérida
- Depto. Bioquímica y Biología Molecular, Facultad de Medicina, Málaga, Spain
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16
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17
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Rodríguez-Miñón Cifuentes JL, Salvador E, Bellanato J, Medina JA. [Silica, aluminum, iron, sulfur, and barium in a urinary calculus]. Actas Urol Esp 1994; 18 Suppl:452-4. [PMID: 8073934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Presentation of the analytical results by Sweep Microscopy of a small papillary calculus spontaneously eliminated after a nephritic colic. The main component is monohydrate calcium oxalate. When the stone core was analyzed with EDAX, silica, aluminium, iron, sulphur and barium were detected. The origin of these elements is discussed and the presence of barium emphasized as exceptional.
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Affiliation(s)
- J L Rodríguez-Miñón Cifuentes
- Servicio de Urología, Fundación Jiménez Diaz, Servicio Interdepartamental de Investigación, Laboratorio Microscopía Electrónica, Universidád Autónoma de Madrid
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18
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Contreras J, Medina JA, Albero A, Herruzo I, Marina E, Azcoaga JM, Bretón JJ. [Neoadjuvant treatment with cisplatin, 5-FU and folinic acid in advanced head and neck cancer]. Acta Otorrinolaringol Esp 1994; 45:87-91. [PMID: 8086215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
From May to February 1992, 32 patients diagnosed as advanced cancer of the head and neck were included in a program of neoadjuvant treatment with cisplatin, 5-FU, and folinic acid, followed by radiotherapy (45 at 70 Gy) and/or surgery. Twenty patients were considered fully evaluable; their global response rate was 75% (7 complete responses and 8 partial responses). Five patients had no appreciable response or progression. Radiotherapy after chemotherapy enhanced the response, yielding complete responses in 4 patients and partial response in 1. Toxicity was moderate, except for mucositis (9 cases grade 3-4), despite high doses of drugs and radiotherapy. Given the clinical results, this combination may be promising as a first-line treatment against advanced cancer of the head and neck.
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Affiliation(s)
- J Contreras
- Servicio de Oncología Radioterápica, Hospital Regional de Málaga
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19
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Ruíz de Aguiar A, Medina JA, Garrido G, Villacorta J, Berenguer J. [Biliary calculi resistant to dissolution with bile acids: their heterogeneous composition and diversity of treatment response]. Rev Esp Enferm Dig 1992; 81:327-32. [PMID: 1616741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We have studied thirteen biliary stones resistant to biliary acids, using technical methods of stereomicroscopy, scanning electronic microscopy and EDX analyses. We have investigated changes on surface. Three biliary stones did not change and were considered resistant. Seven biliary stones appear partially dissolved and we observed many irregularities on surface and/or concentric dips in relation with cholesterol dissolution. In six cases, biliary pigment alternates with cholesterol. In three cases we observed a calcium carbonate coat on surface. One case included organic fibers. One biliary stone showed cholesterol with spherical bodies of calcium carbonate and pigment. It was a relapsed case of combined treatment. Three stones are composed of small black portions of polymerized calcium bilirubinate, rich in copper and iron. Our results demonstrate that biliary stones previously selected for treatment are a heterogeneous group. Because of this fact we get variable and unpredictable results.
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Affiliation(s)
- A Ruíz de Aguiar
- Departamento de Medicina, Hospital Universitario de San Carlos, U.C.M
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20
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Escolar E, Bellanato J, Medina JA. Structure and composition of canine urinary calculi. Res Vet Sci 1990; 49:327-33. [PMID: 2176338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The chemical constituents of 171 specimens of canine urinary calculi have been analysed by infrared spectroscopy. The analysis revealed that 46 per cent of the total contained struvite as the major component; 26 per cent contained cystine; 16 per cent were found to be composed of whewellite and, or, weddellite; 8 per cent of urates; 3 per cent of calcium phosphate (apatite and, or, brushite) and 1 per cent of silica. A series of selected samples was also studied by scanning electron microscopy and energy dispersive X-ray analysis (EDAX). This examination revealed structures similar to human stones. Potassium and complex urates containing two or more cations were commonly found in many areas of ammonium urate and sodium urate calculi. Moreover, EDAX analysis detected a calcium enriched urate in several zones of urate calculi.
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Affiliation(s)
- E Escolar
- Departamento de Patología Animal II, Facultad de Veterinaria, Universidad Complutense de Madrid, Spain
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21
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Affiliation(s)
- J M Toranzo
- Oral and Maxillofacial Surgery, School of Dentistry, Universidad Autonoma, San Luis Potosi, Mexico
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22
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Barzilai A, Medina JA, Toth L, Konturek S, Dreiling DA. The effect of sham feeding on pancreatic secretion: preliminary observations. Mt Sinai J Med 1987; 54:361-5. [PMID: 3498889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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23
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Abstract
Five hundred spontaneously passed stones were collected during a three-year period in an outpatient clinic. They were studied under a stereoscopical optical microscope. Complementary analyses were performed with infrared spectroscopy, scanning electron microscopy and EDAX. There were 142 true papillary stones (28.4%). The rest (71.6%) showed different non-papillary patterns. Papillary stones, type 1 (61 calculi), had an apatite plaque of intrapapillary origin of which 14 showed calcified tubules. Type 2 showed other substances, presumably due to crystalluria but not to an interstitial papillary process (28 stones). Type 3 showed no plaques in their concave faces (53 stones). In types 1 and 2 whewellite is a secondary growth, the plaque acting as a trigger for the development of calcium oxalate. The possibility of hidden Randall's plaques is discussed. Stones with papillary patterns are not as rare as hitherto considered and merit microscopical study.
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24
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Abstract
The aim of this study is to compare the effect of various stimuli on pancreatic secretion in two groups of dogs, one undergoing interruption of the cholinergic and adrenergic branches to the pancreas (long arc reflexes), and the second group undergoing total denervation of the pancreas by its isolation from stomach and duodenum (short arc reflexes). Stimulation of pancreatic secretion was accomplished by (a) hormonal, by i.v. secretin and CCK/PZ and (b) reflex stimulation by intraduodenal administration of fat (Na oleate) or amino acids (Aminosyn). After a few weeks of collected data in stimulated controls, the dogs were divided into two groups: (A) Four dogs underwent proximal truncal vagotomy, celiac ganglionectomy, and stripping of the common hepatic and gastroduodenal arteries for 2-3 cm. (B) Four dogs underwent the same procedures, but in addition the pancreas was dissected away from its vascular and nervous attachments to the duodenal wall and pyloric region, as well as from its mesenteric and peritoneal attachments. All animals were then tested with secretin, Cholecystokinin/pancreozymin (CCK/PZ), intraduodenal fat, and intraduodenal amino acids. The data obtained indicate that secretion of pancreatic bicarbonate is dependent on intact local duodeno-pancreatic nervous reflexes. Fat and amino acids stimulate the secretion of bicarbonate only when the attachments of the pancreas to the stomach and duodenum are intact. Stimulation by secretion or CCK, being humoral-hormonal mediators, appears not to be affected by the local denervation.
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25
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Barzilai A, Ryback BJ, Medina JA, Toth L, Dreiling DA. The morphological changes of the pancreas in hypovolemic shock and the effect of pretreatment with steroids. Int J Pancreatol 1987; 2:23-32. [PMID: 3681033 DOI: 10.1007/bf02788346] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Previous reports from this laboratory have described the effect of hypovolemic shock of varying duration on the exocrine function of the pancreas, and the ability of steroids to reverse the inhibition of secretion observed. This report is a study of pancreatic morphology in prolonged hypovolemia, as well as the effect of steroid pretreatment on the pathology observed. Twelve mongrel dogs were divided into two groups, one with and one without steroid pretreatment. The animals were bled until at least 30-35% of their blood had been withdrawn, or until mean blood pressure (BP) dropped to around 60 mmHg. When BP dropped to 80-90% mmHg, six animals received intravenous (i.v.) prednisolone in 50 cc of 0.9% NaCl, at the rate of 10 cc/min, for a dosage of 30 mg/kg. Of the twelve dogs, six were exposed to 120 min of hypovolemia, and six to 180 min. At the end of the observed hypovolemic period, the blood withdrawn was quickly retransfused. After an hour of recovery, the animals were killed and their pancreases removed. The pancreases were weighed, fixed and examined by light microscopy. Three pancreases were obtained as control from animals not subjected to shock or steroids. The steroid-treated animals displayed an insignificant (5%) increase in pancreatic weight following prolonged hypovolemia. Untreated canine pancreases, on the other hand, showed a significant weight gain (37%, P less than 0.001) after 3 h of hypovolemia. Microscopically, the untreated group revealed marked interstitial edema, hemorrhage and inflammation, as well as focal acinar cell necrosis and fat necrosis, while in the steroid group only very mild edema and inflammatory changes were seen. This study indicates a beneficial effect of steroids on the morphological changes seen in shock-induced pancreatitis in canines and a possible use in the therapy of acute pancreatitis in man.
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Affiliation(s)
- A Barzilai
- Pancreatic Research Laboratory, Mount Sinai School of Medicine, City University of New York, NY 10029
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26
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Abstract
A vascular pathogenesis of pancreatitis has been postulated in diabetics, the aged, Ortner's Syndrome, and various low-flow states. This report studies canine pancreatic secretion in a preparation of hypovolemic shock produced by controlled hemorrhage maintained for varying durations. Pancreatic secretion was collected by cannulation of the main pancreatic duct in anesthetized dogs. Secretin was administered by continuous intravenous (i.v.) infusion of 4 U/kg/h. Four 15-min samples of pancreatic juice were collected. Then the dogs were bled by arterial line withdrawing 25-30% of total blood volume or until the mean blood pressure dropped to about 60 mmHg. Blood was collected in heparinized containers for reinfusion. Blood samples for amylase and 15-min samples of pancreatic juice for volume, bicarbonate, and enzymes were obtained during hypovolemia as well as during and following restoration of the blood volume. Hypovolemia induced significant decreases in pancreatic flow, bicarbonate and amylase secretion, parameters which increased after reinfusion but never returned to pre-shock levels. Increasing the period of hypovolemia increased the inhibition of pancreatic flow, increased blood amylase elevation, and resulted in visible pancreatic edema. We conclude that pancreatic secretion is diminished by hypovolemia, that this is initially reversible when hypovolemia is brief, but that the disturbance of function progresses to inflammatory pathology when hypovolemia is prolonged.
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Affiliation(s)
- A Barzilai
- Pancreatic Research Laboratory, Mount Sinai School of Medicine, CUNY, NY 10029
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27
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Barzilai A, Medina JA, Toth L, Dreiling DA. The effect of steroid administration on pancreatic secretion during and after hypovolemic shock. Int J Pancreatol 1986; 1:381-8. [PMID: 2445871 DOI: 10.1007/bf02801870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In a previous report from this laboratory, 1 h of hypovolemia induced a significant decrease in pancreatic flow, bicarbonate and enzyme secretion. These parameters recover after restoration of blood volume, but never return to pre-shock levels. Furthermore, increasing the period of hypovolemia produced further decreases in pancreatic flow and bicarbonate secretion only. Enzyme secretion, however, rose significantly, probably due to leakage of protein through damaged cell membranes. Prolonged hypovolemia was also accompanied by visible edema. This model of secretory changes induced by fixed periods of hypovolemic shock is ideal to study the effect of steroids on secretion and to assess its possible cytoprotective properties against early induced ischemia pancreatic pathology. Pancreatic secretion was collected by cannulation of the main pancreatic duct in 12 anesthetized dogs. Secretin was administered by continuous intravenous (i.v.) infusion at 4 U/kg/h. Four 15-min samples of pancreatic juice were collected. Then the dogs were bled, withdrawing 25-30% of total blood volume or until the mean blood pressure dropped to about 60 mmHg. At this point, 30 mg/kg of methyl prednisolone were given in 50 cm3 of NaCl i.v. to six animals. Blood samples for amylase and 15-min collections of pancreatic juice for volume, bicarbonate and enzymes were obtained during hypovolemia, as well as during and following the restoration of blood volume. The responses of the two groups differed as follows: (1) Instead of the increase in protein enzyme secretion seen in the non-steroid group with increased duration of hypovolemia, steroid-treated dogs displayed a significant decrease in protein output.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A Barzilai
- Pancreatic Research Laboratory, Mount Sinai School of Medicine, CUNY, NY
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28
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Fernández Conde M, Cifuentes Delatte L, Medina JA, Rodríguez-Miñón Cifuentes JL, Caralps A. [Nucleus with calcified renal tubules in the interior of a small whewellite calculus]. ARCH ESP UROL 1986; 39:71-3. [PMID: 3707214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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29
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Abstract
Papillary stones are small, rounded concretions with one smooth convex face and one concave face which corresponds to its implantation on the papilla and in which a whitish Randall's plaque is often present. Eighty-seven papillary stones were studied with stereoscopic, scanning electron microscopic and x-ray dispersive energy analysis. Sixty-three stones had a plaque and 13 of these showed calcified renal tubules that demonstrated their intrapapillary origin and a link between partial papillary nephrocalcinosis and renal stones.
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30
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Cueto-García L, Maisterrena J, Bolaños F, Medina JA, Arriaga J. Thyrotoxicosis associated with sick sinus syndrome: a diagnostic and therapeutic dilemma. Rev Invest Clin 1985; 37:35-7. [PMID: 4001616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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31
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Cifuentes Delatte L, Medina JA, Miñón Cifuentes JL. [Papillary calculi with atypical plaques]. ARCH ESP UROL 1984; 37 Suppl 1:569-76. [PMID: 6534270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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32
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de Carvalho Filho ET, Pasini U, Medina JA, de Serro Azul LG. [The electrocardiogram of the elderly patient with arterial hypertension]. Arq Bras Cardiol 1983; 41:357-61. [PMID: 6232912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Medina JA, Cifuentes Delatte L. [Calcified papillary necrosis as the nucleus for a calculus]. ARCH ESP UROL 1983; 36:154-7. [PMID: 6625687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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34
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Cifuentes Delatte L, Medina JA, Traba ML. [A calcium sulfate calculus of renal origin. A verifiable observation?]. ARCH ESP UROL 1983; 36:117-23. [PMID: 6625682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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35
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Carrillo Penso N, Carrasquero O, Medina JA. [Hyperlipemia and pancreatitis]. G E N 1981; 35:15-27. [PMID: 6816659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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36
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Medina JA, Cifuentes Delatte L. [Potassium urate in urinary tract calculi]. ARCH ESP UROL 1981; 34:81-6. [PMID: 7259317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In a study of renal calculi, performed with scanning electronic microscope, Edax, element mapping and semiquantitative analysis with a Nova 2 computer, we have found, among the urates, ratios K/Na from 0.016, in the almost pure monosodium urate stones, to 1.856 in other areas. The presence of monopotassium urate has, to our knowledge, no previous reference in the literature on human lithiasis.
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Cifuentes Delatte L, Santos M, Medina JA. [Garnet-like structure of kidney calculi]. Z Urol Nephrol 1979; 72:417-25. [PMID: 484064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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38
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Medina JA, Rodríguez J, Santos M, Cifuentes Delatte L. [Siliceous renal calculi in a man (11th case in the world)]. Rev Clin Esp 1978; 151:411-3. [PMID: 217047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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39
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Biagi F, Medina JA. [Pamoate of pyrantel, an anthelminitic drug]. Prensa Med Mex 1974; 39:440-3. [PMID: 4457880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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40
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Urdaneta F, Guédez Lima PG, Medina JA, Arreaza Caliza N. [Child care in hospitals and ambulatorium. Statistical data]. Rev Venez Sanid Asist Soc 1965; 30:164-74. [PMID: 5874364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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